CMS makes 2025 Medicare cuts official—and doctors are not happy
After months of debate and discussion, the Centers for Medicare and Medicaid Services (CMS) has released its final rule for the 2025 Medicare Physician Fee Schedule (MPFS).
According to the new rule, the 2025 conversion factor is $32.36, down approximately 2.8% from 2024. The conversion factor is perhaps the most important aspect of the MPFS, because Medicare programs are required by law to be budget neutral. CMS can only increase reimbursements for a service if they decrease reimbursements for another service so the budget allocated to Medicare remains balanced. Physician advocates have been pushing policymakers to update this policy for years.
CMS estimates that the cut will not make a significant impact on cardiology services, though it does say cardiac surgeons could see a 1% reduction in total allowed charges.
The American Medical Association (AMA) issued an immediate response to the final rule, highlighting the urgency for Congress to pass legislation that could stop the latest cut from going into effect.
“To put it bluntly, Medicare plans to pay us less while costs go up,” AMA President Bruce A. Scott, MD, said in the statement. “You don’t have to be an economist to know that is an unsustainable trend, though one that has been going on for decades. For physician practices operating on small margins already, this means it is harder to acquire new equipment, harder to retain staff, harder to take on new Medicare patients, and harder to keep the doors open, particularly in rural and underserved areas.”
The Medical Group Management Association (MGMA), which represents more than 15,000 organizations, published its own response.
“CMS and Congress have once again overlooked the sobering financial realities facing our nation's medical practices, finalizing a 2.83% reduction to the 2025 Medicare conversion factor, further increasing the gap between practice expenses and reimbursement rates,” Anders Gilberg, MGMA’s senior vice president of government affairs, said in the group’s statement. “Today's final rule throws the financial viability of physician practices into question and threatens beneficiary access to care.”
Gilberg outlined his primary issues with the 2025 MPFS in a recent video interview with Health Exec.
Cardiology groups worked to prevent Medicare cuts
U.S. medical societies focused on cardiology and cardiovascular health had hoped CMS would reconsider the 2.8% conversion factor cut. In July, the American College of Cardiology (ACC), American Society of Nuclear Cardiology (ASNC), Society for Cardiovascular Angiography and Interventions (SCAI), Heart Rhythm Society (HRS), Society for Cardiovascular Magnetic Resonance (SCMR), Society of Cardiovascular Computed Tomography (SCCT), Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) all signed a letter asking federal policymakers to prioritize legislation that could put such cuts to an end once and for all.
Many of those same groups spent the following months advocating for new payment policies. Just days ago, for example, the ACC shared its support for the Medicare Patient Access and Practice Stabilization Act of 2024, new legislation introduced in the House of Representatives by a bipartisan group of U.S. representatives. The bill, if passed, would stop the 2.8% reduction in its tracks.
“Although heart disease remains the No. 1 killer in the United States, cardiology practices can expect to see a decrease of $168 million if this cut takes effect next year,” ACC President Cathie Biga said in a statement on Oct. 31. “On top of consecutive reductions from 2021 to 2024, this is unacceptable and unsustainable. Our nation's health and well-being must be prioritized, especially for those disproportionately affected, including rural, senior, and other vulnerable populations. The ACC is encouraged by recent efforts in Congress to address this issue, particularly with the recent introduction of the Medicare Patient Access and Practice Stabilization Act of 2024.”
CMS finalizing ASCVD risk assessment policy
In the final rule, CMS noted that researchers who tested the effectiveness of the Million Hearts Model for evaluating atherosclerotic cardiovascular disease (ASCVD) risk found it is associated with significant improvements in patient outcomes and could make a significant impact on patient care for Medicare fee-for-service beneficiaries.
CMS is now finalizing coding and payment associated with the program, which uses as “standardized, evidence-based” method to evaluate a patient’s 10-year risk of developing ASCVD. Specialists reviewed years of data highlighting the impact of the Million Hearts Model before reaching this conclusion.
For more details from CMS on this significant policy update, click here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.